Addictive Behaviors 38 (2013) 2690–2706 Contents lists available at ScienceDirect Addictive Behaviors Review Understanding the relationship between social anxiety and alcohol use in college students: A meta-analysis Amie R. Schry ⁎, Susan W. White Virginia Tech, Department of Psychology, 109 Williams Hall (0436), Blacksburg, VA 24061, United States HIGHLIGHTS • Meta-analysis examining social anxiety and alcohol variables in college students. • Social anxiety (SA) was negatively related to alcohol use. • SA was positively related to alcohol-related problems. • Drinking motives and alcohol outcome expectancies were positively related to SA. • Clinicians should be aware of these relationships for treatment and assessment. article info abstract Keywords: Many college students use alcohol, and most of these students experience problems related to their Social anxiety use. Emerging research indicates that socially anxious students face heightened risk of experiencing Alcohol alcohol-related problems, althoughtheextantresearchonalcoholuseandsocialanxietyinthispopula- Undergraduates tion has yielded inconsistent findings. This meta-analysis was conducted to examine the relationship Meta-analysis between social anxiety and alcohol variables in college students. A literature search was used to identify studies on college students that included measures of social anxiety and at least one of the alcohol vari- ables of interest. All analyses were conducted using random effects models. We found that social anxiety was negatively correlated with alcohol use variables (e.g., typical quantity and typical frequency), but significantly positively correlated with alcohol-related problems, coping, conformity, and social motives for alcohol use, and positive and negative alcohol outcome expectancies. Several moderators of effect sizes were found to be significant, including methodological factors such as sample ascertainment approach. Given that social anxiety was negatively related to alcohol use but positively related to alcohol-related problems, research is needed to address why individuals high in social anxiety experi- ence more problems as a result of their alcohol use. Avoidance of social situations among socially anxious students should also be taken into account when measuring alcohol use. The primary limitation of this study is the small number of studies available for inclusion in some of the analyses. © 2013 Elsevier Ltd. All rights reserved. Contents 1. Introduction ............................................................. 2691 1.1. Social anxiety and alcohol ................................................... 2691 1.2. Potential mediators: Drinking motives and alcohol outcome expectancies . .......................... 2692 1.3. Potential moderators ..................................................... 2692 1.4. Hypotheses .......................................................... 2693 2. Materials and methods ........................................................ 2693 2.1. Operational definitions .................................................... 2693 2.2. Literature search ....................................................... 2693 ⁎ Corresponding author at: Department of Psychology, Virginia Tech, 109 Williams Hall (0436), Blacksburg, VA 24061, United States. Tel.: +1 540 231 6744; fax: +1 540 231 3652. E-mail addresses: [email protected] (A.R. Schry), [email protected] (S.W. White). 0306-4603/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.addbeh.2013.06.014 A.R. Schry, S.W. White / Addictive Behaviors 38 (2013) 2690–2706 2691 2.3. Study inclusion criteria and resulting pool of studies ....................................... 2693 2.4. Study coding .......................................................... 2694 2.4.1. Categorical moderators ................................................. 2694 2.4.2. Continuous moderators ................................................. 2696 2.5. Effect sizes ........................................................... 2697 2.6. Statistical analyses ....................................................... 2697 3. Results ................................................................ 2697 3.1. Mean effect sizes and homogeneity analyses ........................................... 2697 3.2. Analyses of moderator variables................................................. 2697 4. Discussion .............................................................. 2698 4.1. Limitations ........................................................... 2700 4.2. Recommendations for future research .............................................. 2700 4.3. Clinical implications ...................................................... 2700 4.4. Conclusions .......................................................... 2700 Role of funding sources ........................................................... 2700 Contributors ................................................................ 2700 Conflict of interest ............................................................. 2700 Acknowledgments ............................................................. 2700 Appendix A. .............................................................. 27002701 References ................................................................. 2705 1. Introduction dampening effect of alcohol on social anxiety and because college students are likely to be in situations where drinking, often to Alcohol is, by far, the most widely used drug among college excess, is the social norm, understanding relationships among students, with 60.8% of students reporting alcohol use in the past social anxiety and alcohol-related variables may be particularly month (Substance Abuse & Mental Health Services Administration, relevant. 2012). In 2009, 61.5% of college students reported that they had Social anxiety disorder (SAD) and alcohol use disorders (AUDs) been intoxicated at least once in the past year, with 42.4% reporting are frequently comorbid (see Morris, Stewart, and Ham (2005), that they had been intoxicated in the past 30 days (Johnston, for a review). Approximately 13% of adults with past-year SAD O'Malley, Bachman, & Schulenberg, 2010). Approximately 37 to met criteria for a comorbid AUD, and of adults with lifetime SAD, 44% of college students reported that they binge drank at least 48.2% met criteria for an AUD (Grant et al., 2005). This relationship once in the past two weeks to month (Hingson, Heeren, Winter, & appears to be due to a greater likelihood of having comorbid alcohol Wechsler, 2005; Johnston et al., 2010; Wechsler et al., 2002). dependence (characterized by tolerance, withdrawal, or compulsive Alcohol use can lead to a wide range of problems (e.g., involve- alcohol consumption (APA, 2000); OR = 2.26 to 2.7) rather than ment in risky sexual situations, driving under the influence, hang- alcohol abuse (characterized by a pattern of negative consequences overs, nausea and vomiting, and aggression). Due to the high that result from alcohol use (APA, 2000); OR = 1.2 to 1.23; Buckner, levels of alcohol consumption and the contexts in which college Timpano, Zvolensky, Sachs-Ericsson, & Schmidt, 2008; Grant et al., students typically consume alcohol (e.g., parties where excessive 2005). Both retrospective and longitudinal studies have shown drinking is the norm), along with no parental oversight and moni- that when SAD and AUD co-occur, SAD typically precedes the onset toring, this population may be particularly likely to experience of the AUD (Buckner, Schmidt, et al., 2008; Buckner, Timpano, et al., alcohol-related problems (ARPs). Of college students who drank 2008; Buckner & Turner, 2009; Falk, Yi, & Hilton, 2008). at least once per week during their first year of college, 80% ex- Consistent with studies of adults, Kushner and Sher (1993) found perienced more than one ARP during their first year, and 34% that 43% of college freshmen with SAD met diagnostic criteria for an reported that they had experienced six or more ARPs during that AUD while only 26% of college freshman without SAD met criteria time (Mallett et al., 2011). for an AUD. Overall, however, research on the relationship between social anxiety and alcohol use among college students has revealed 1.1. Social anxiety and alcohol very mixed findings (see Morris et al. (2005), for a review). Some laboratory studies have demonstrated that socially anxious par- It is important for practitioners who work with this population ticipants drink more in anticipation of both interaction (Higgins to be aware of other problems that may be associated with, or lead & Marlatt, 1975) and speech tasks (Kidorf & Lang, 1999), whereas to, problematic alcohol use in order to best treat students, even others (e.g., Holroyd, 1978) have found that socially anxious students when ARPs are not the primary presenting concern. Social anxiety, drink significantly less alcohol than non-socially anxious peers during defined as a fear of being observed or negatively evaluated by others informal laboratory-based “get togethers.” Survey studies of college (American Psychiatric Association [APA], 2000), has been studied students have either failed to find a relationship between social in relation to alcohol use among college students. For individuals anxiety and alcohol consumption, or have found an inverse relation- with high levels of social anxiety, fear of negative evaluation ship between social anxiety and alcohol consumption (e.g., Buckner, may play a role in their alcohol use, as they